Clinical Risk Manager

1 month ago


Pretoria, Gauteng, South Africa Oasis Healthservices Full time
Job Title: Clinical Risk Manager

Oasis Health Services is seeking a highly skilled Clinical Risk Manager to join our team. As a key member of our patient services department, you will be responsible for managing the financial and clinical risks of patients in our general ward.

Key Responsibilities:
  • Ensure accurate coding and clinical updates to achieve strategic objectives
  • Participate in meetings and report losses to the RSRT team, recommending corrective actions
  • Monitor insurance verification and workflow processes
  • Implement and monitor quality improvement programs
  • Adhere to patient services escalation processes to achieve QMS targets
  • Investigate internal and external stakeholder complaints
  • Ensure compliance with LHC policies and manage authorizations and claim submissions, rejections, and delays
  • Ensure governance and risk management by monitoring and adhering to patient services policies and procedures
Requirements:
  • Nursing qualification with at least three to five years' experience
  • Current SANC registration
  • Knowledge of hospital patient services and case management processes
  • Knowledge and understanding of CPT & ICD coding
  • Knowledge of Funder contracts, scheme rules, exclusions, and benefits
What We Offer:

Oasis Health Services offers a dynamic and supportive work environment, with opportunities for professional growth and development. If you are a motivated and experienced Clinical Risk Manager looking for a new challenge, we encourage you to apply.



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